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For Seniors
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News & Events

Registration

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Event Registration Form

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REGISTRATION FOR THIS EVENT HAS CLOSED.

Registration for this program is full. If you are interested in this program please call 269-966-2450 to be put on the waitlist.

This is an 8-week series. By registering for the event, participants should plan to attend all sessions.

This is an 8-week series [No session on July 14]. By registering for the event, participants should plan to attend all sessions.

This is a 6-week series. By registering for the event, participants should plan to attend all sessions.

This is a 6-week series. By registering for the event, participants should plan to attend all sessions. Series runs January 5 - February 23, with no class on January 19 or February 16. Snow days to be scheduled at the discretion of the instructor.

This is a virtual event. Zoom link will be sent after registration.

This is a three-part series. By registering for the event, you are registering for all presentations.

Respite care may be available for this program upon request.

Please check the box below if you are in need of respite care and we will follow up with you.

Yes

No

Registration with or without lunch is required by the Wednesday prior at 3:00pm. Lunches are now ordered from Uproot Eatery, a community co-op that uses locally sourced food. Lunches come with assorted chips and fruit. The cost for lunch is now $7, due on arrival.

Name(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

How did you hear about this program?

Number of people attending?

Please enter a number from 1 to 5.

Additional Guests Attending

If additional guests are attending, please list their names here.

Please select your lunch sandwich option ($7 per lunch)(Required)

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Lunches are now ordered from Uproot Eatery, a community co-op that uses locally sourced food. Due to the change, the cost for lunch is now $7. Lunches come with assorted chips and fruit.

Please select your lunch sandwich option(Required)

Boxed lunch is being provided at this event. No charge. Please select your lunch option below.

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option ($7 per lunch)

Guest #1

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option ($7 per lunch)

Guest #2

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option ($7 per lunch)

Guest #3

Turkey Wrap

Veggie Wrap

Ham Wrap

None

Please select your lunch sandwich option ($7 per lunch)

Guest #4

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option

Guest #1

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option

Guest #2

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option

Guest #3

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

Please select your lunch sandwich option

Guest #4

Turkey & Havarti on Sourdough

Ham & Cheddar on Sourdough

Tuna & Havarti on Country White

Chickpea on Whole Wheat

None

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info@carewellservices.org

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